Tranexamic acid in the German emergency medical service

A national survey

Abstract

Background

Trauma-induced coagulopathy, one of the leading causes of trauma-related death, is detected in about one of four trauma patients upon hospital admission. The current European Management of Major Bleeding and Coagulopathy Following Trauma guidelines, published in 2013, recommend that tranexamic acid (TXA) be administered as early as possible to inhibit hyperfibrinolysis (grade of recommendation (GoR 1A)). Furthermore, it is suggested that protocols for the management of patients with bleeding or showing signs of bleeding include the administration of the first dose of TXA at the site of injury or during transportation to hospital (GoR 2C).

There is no current data showing to what extent TXA is used in the pre-hospital settings in Germany.

Objectives

This study aimed to collect data about the availability of TXA in the German emergency medical service (EMS). We tried to determine how many EMS stored and used TXA, under which circumstances the substance was used and whether any standard operating procedures (SOPs) were in use. The study also tried to determine what dosage recommendations exist.

Materials and methods

Between 1 July and 31 August 2015, a total of 326 German emergency medical directors (EMDs) were asked to take part in a survey, which involved answering an online questionnaire.

Results

Altogether 163 EMD answered the questionnaire (response rate 50%). The results showed that 52.8% of EMDs stored TXA in their vehicles and 26% planned to do so in the future. The availability of TXA in the EMS has increased since 2010. Most EMDs stated that guidelines were the reason for this. SOPs existed in 17.4%. Dosage recommendations were defined by the EMDs in 76.7%. More than 80% of dosage recommendations followed the European guideline.

Conclusion

The survey shows a widespread distribution of TXA in the German EMS, which has significantly increased between 2010 and 2015. However, nationwide distribution has not yet been established.

This rise in distribution is interpreted as a reaction to national and European guidelines for the management of severe bleeding and trauma care.

A remaining question is to determine which patients should be treated with TXA, as hyperfibrinolysis is not detectable at the site of injury.